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News Analysis If vaccines and drugs are available too late to stop bird flu, then what can be done to battle H5N1 avian influenza if it spreads to people? Not a lot, experts say.

If a pandemic emerges in the coming year, there will not be enough supplies of drugs or vaccines to stop it and basic medical equipment that could slow its spread is also lacking.

World leaders have been stepping up their efforts to battle avian influenza in recent weeks, holding meetings, making international visits and ordering vaccines and drugs.

US health and human services secretary Mike Leavitt and a contingent of US and World Health Organization (WHO) flu experts are visiting affected southeast Asian nations this week and diplomats are working to make better alliances for sharing information quickly about any human outbreaks.

But many experts agree that little real progress has been made in stopping the spread of H5N1 bird flu.

"To believe that you can contain this locally is to believe in fairy tales," says Dr Mike Osterholm, an infectious disease specialist at the University of Minnesota who has advised the US government on avian flu and warned of the danger of a flu pandemic for years.

WHO officials say many countries still seem to be reluctant to share information and to ask for help if the pandemic begins within their borders.

Dr Margaret Chan, WHO assistant director-general for communicable diseases, told The Times newspaper in the UK that cooperation had worsened since the 2003 outbreak of severe acute respiratory syndrome, which killed about 800 people before it was contained.

"That was a time when we were really working together as an international community of academics, politicians, public health experts. Everybody really was so focused," the newspaper quotes Chan as saying.

Not scary enough yet

"Everybody was trying to do his or her best to contain the spread of this disease. The thing with avian flu is we are not yet in a pandemic."

The H5N1 bird flu virus has killed at least 65 people in four Asian nations since late 2003, and has killed or forced the destruction of tens of millions of chickens, ducks and geese.

Experts say it is mutating steadily and fear it will eventually acquire the changes it needs to spread easily from person to person. If it did, it could sweep around the world in months or even weeks and could kill millions of people.

"Many hospital emergency departments in this country are operating at, or over current capacity," says College president Dr Rick Blum.

"We as a nation, have poured millions of dollars into preparedness, but virtually none of that has gone to the one place that is the true first response to something like a flu epidemic, or a hurricane, or a terrorist attack: the nation's emergency departments."

And even if the drugs and vaccines were in place, it would take immediate detection of a mutated virus in a group of people and immediate action to contain it.

That would mean having diagnostic tests and experts on hand in rural and remote parts of Vietnam, Cambodia, Thailand, South Korea, Indonesia and other countries to immediately test patients with flu-like symptoms and then isolate and treat them and their families.

"If you can't do it with the speed of a smoke alarm and a fire truck, you don't have a chance in hell of stopping this," says Osterholm.

Animal experts say good hygiene could help contain H5N1 before it spreads to people.

Measures would include penning in ducks and chickens, who often wander freely on Asian farms, allowing the spread of virus from animal to animal and perhaps allowing it to spread in droppings.

Leavitt inspected a Thai farm this week where a shoe bath, disinfectant room and plastic netting had been installed.

But few farms have such equipment, says Dr Alejandro Thiermann, president of the International Animal Health Code at the Paris-based animal health body OIE.

"There is much talk about humans but not about birds," Thiermann says, echoing complaints from other US experts.